Edelstein Burton L
Children's Dental Health Project, Washington, DC 20036, USA.
Ambul Pediatr. 2002 Mar-Apr;2(2 Suppl):141-7. doi: 10.1367/1539-4409(2002)002<0141:diohaa>2.0.co;2.
In this background paper, sociodemographic variables, including age, race, family income, sex, parental education, and geographic location, have been used to characterize the dental status of US children and their access to dental services. Because tooth decay, or dental caries, remains the preeminent oral disease of childhood and national data is available on dental office visits, tooth decay has been used as the primary marker for children's oral health, and visits to the dentist is the marker for care. In general, children from low-income families experience the greatest amount of oral disease, the most extensive disease, and the most frequent use of dental services for pain relief. Yet these children have the fewest overall dental visits. Paradoxically, children in poverty-those living in households with annual gross incomes under $16 500 for a family of 4-or near poverty-those in family households with incomes between $16 500 and $33 000-also have the highest rates of dental insurance coverage, primarily through Medicaid and SCHIP. For those most affected, dental disease is consequential for their growth, function, behavior, and comfort. The twin disparities of poor oral health and lack of dental care are most evident among low-income preschool children, who are twice as likely to have cavities as are higher income children. Medicaid-eligible children who have cavities have twice the numbers of decayed teeth and twice the number of visits for pain relief but fewer total dental visits, compared to children coming from families with higher incomes. Fewer preventive visits for services such as sealants increase the burden of disease in low-income children. These disparities continue into adolescence and young adulthood, but to a lesser degree. Disparities in oral health status and access to dental care are also evident when comparing black, Hispanic, and Native American children to white children and when comparing children of parents with low educational attainment to children of parents with higher educational attainment. The fastest growing populations of children are those that currently have the highest disease rates and the lowest amount of dental care. If the strong correlation between these subpopulations and dental diseases continues, caries rates are likely to rebound after longstanding declines, and the stress on publicly financed dental care will likely increase.
在这份背景文件中，社会人口统计学变量，包括年龄、种族、家庭收入、性别、父母教育程度和地理位置，已被用于描述美国儿童的牙齿状况及其获得牙科服务的情况。由于龋齿仍然是儿童期最主要的口腔疾病，并且有全国性的牙科就诊数据，龋齿已被用作儿童口腔健康的主要指标，而看牙医则是获得护理的指标。一般来说，来自低收入家庭的儿童患口腔疾病的数量最多、疾病范围最广，并且因疼痛缓解而使用牙科服务的频率最高。然而，这些儿童的总体牙科就诊次数却最少。矛盾的是，贫困儿童（即四口之家年收入低于16500美元的家庭中的儿童）或接近贫困的儿童（即家庭收入在16500美元至33000美元之间的家庭中的儿童），其牙科保险覆盖率也最高，主要通过医疗补助和儿童健康保险计划（SCHIP）。对于那些受影响最大的儿童来说，牙科疾病会对他们的生长、功能、行为和舒适度产生影响。口腔健康状况差和缺乏牙科护理这两个差异在低收入学龄前儿童中最为明显，他们患龋齿的可能性是高收入儿童的两倍。与来自高收入家庭的儿童相比，符合医疗补助条件且患有龋齿的儿童，其龋齿数量是前者的两倍，因疼痛缓解而就诊的次数也是前者的两倍，但总的牙科就诊次数却更少。诸如窝沟封闭等预防性服务的就诊次数减少，增加了低收入儿童的疾病负担。这些差异一直持续到青少年期和青年期，但程度较轻。在将黑人、西班牙裔和美国原住民儿童与白人儿童进行比较，以及将父母教育程度低的儿童与父母教育程度高的儿童进行比较时，口腔健康状况和获得牙科护理方面的差异也很明显。目前，儿童中增长最快的群体是那些疾病发生率最高且牙科护理最少的群体。如果这些亚群体与牙科疾病之间的强相关性持续存在，则龋齿率可能在长期下降后反弹，并且公共资助的牙科护理的压力可能会增加。
